[Incidence of incontinence after radical prostatectomy using claims-based data]. / Hoe vaak incontinentie na radicale prostatectomie?

OBJECTIVE: To determine the effect of radical prostatectomy (RP) hospital volume on the probability of post-RP incontinence. DESIGN: Retrospective research based on claims-based data of health insurers. METHOD: For every patient with RP the probability of incontinence was determined, based on the definition of claims of one or more incontinence pads per day. Casemix corrections were made based on indicators available in claims-data: age, lymph node dissection, and radiotherapy. No casemix corrections could be made for tumour stage and surgical technique. RESULTS: A total of 1590 patients were included in this study; for 26.0% of these patients, an average of one or more incontinence pads per day were claimed for. A significant relation between the volume of RP per hospital and the claims of incontinence material was observed. The probability of incontinence was significantly lower in hospitals with a volume of more than 100 RP patients per year when compared to hospitals with less than 100 RP patients per year. CONCLUSION: The probability of post-RP incontinence decreases as hospitals conduct more RP procedures. The casemix factors included in the analysis only had a limited impact on this observation.

The impact of trunk impairment on performance-determining activities in wheelchair rugby.

In Paralympic sport, classification of impairment is needed to prevent a one-sided and predictable outcome of competition, in which the least impaired athlete has the best chance to win. To develop evidence-based classification in wheelchair rugby, the impact of trunk impairment, measured by the Trunk Impairment Classification (TIC), on performance-determining activities was assessed. Arm impairment was analyzed as a covariant. Fifty-five athletes, 21 with TIC score 0, 13 with TIC score 0.5, 11 with TIC score 1.0, and 10 with TIC score 1.5 performed standardized sport-specific activities. A multiple step forward regression analysis was performed for all activities to assess the relative impact of trunk and arm impairment on performance. Trunk impairment was the most important factor for tilting the chair and acceleration in the first 2 m. The explained variance of the performance by trunk and arm impairment ranged from 23% for acceleration in the first meter, to 37% for sprint momentum, the tilt test left, and the time to cover 3 and 4 m. This study shows that athletes with limited trunk impairment are more proficient in wheelchair rugby than athletes with severe trunk impairment.

Can mastication in children with cerebral palsy be analyzed by clinical observation, dynamic ultrasound and 3D kinematics?

The aim of this study was to explore the feasibility of the Mastication Observation and Evaluation (MOE) instrument, dynamic ultrasound and 3D kinematic measurements to describe mastication in children with spastic cerebral palsy and typically developing children. Masticatory movements during five trials of eating a biscuit were assessed in 8 children with cerebral palsy, spastic type (mean age 9.08years) and 14 typically developing children (mean age 9.01years). Differences between trials were tested (t-test) and the mastication of individual children with cerebral palsy was analyzed. MOE scores ranged from 17 to 31 (median 24) for the children with cerebral palsy and from 28 to 32 (median 31) for the typically developing children. There was an increased chewing cycle duration, a smaller left-right and up-down tongue displacement and larger anterior mandible movements for the trials (n=40) of cerebral palsy children (p<0.000 for all comparisons) compared to the trials of typically developing children (n=70). The MOE captures differences in mastication between individual children with cerebral palsy. The MOE items 'jaw movement' and 'fluency and coordination' showed the most similarity with the objective measurements. Objective measurements of dynamic ultrasound and 3D kinematics complemented data from the MOE instrument.

Reliability of the revised wheelchair rugby trunk impairment classification system.

STUDY DESIGN: Observational, cross-sectional. OBJECTIVES: A new classification system for trunk impairment in wheelchair rugby was introduced in 2010. It consists of 10 tests, arranged in an algorithm, to assign four different trunk scores (0, 0.5, 1.0 or 1.5) to athletes. The purpose of this study was to assess the inter-rater reliability of this classification system. SETTING: National competition for wheelchair rugby and wheelchair basketball in the Netherlands and Belgium. METHODS: Three experienced wheelchair rugby classifiers independently assigned trunk scores to wheelchair rugby and wheelchair basketball athletes in two sessions. After each session, test descriptions were adjusted. The inter-rater reliability was evaluated by determining the agreement and Fleiss Kappa. RESULTS: In the first session, all classifiers agreed on the trunk score in 13 out of 16 athletes; the overall Kappa was 0.76 (P<0.001). The Kappa per trunk score ranged from 0.29 to 1. Four test descriptions were adjusted after the first session. In the second session, there was an agreement in trunk score between the classifiers in 15 out of 21 athletes. The overall Kappa was 0.75 (P<0.0001), and the Kappa per trunk scores ranged from 0.58 to 0.92. After the second session, two test descriptions were improved. CONCLUSION: The revised classification system for trunk impairment in wheelchair rugby showed a adequate inter-rater reliability for the allocation of trunk scores.

Assessment of mastication in healthy children and children with cerebral palsy: a validity and consistency study.

The aim of this study was to develop the Mastication Observation and Evaluation instrument for observing and assessing the chewing ability of children eating solid and lumpy foods. This study describes the process of item definition and item selection and reports the content validity, reproducibility and consistency of the instrument. In the developmental phase, 15 experienced speech therapists assessed item relevance and descriptions over three Delphi rounds. Potential items were selected based on the results from a literature review. At the initial Delphi round, 17 potential items were included. After three Delphi rounds, 14 items that regarded as providing distinctive value in assessment of mastication (consensus >75%) were included in the Mastication Observation and Evaluation instrument. To test item reproducibility and consistency, two experts and five students evaluated video recordings of 20 children (10 children with cerebral palsy aged 29-65 months and 10 healthy children aged 11-42 months) eating bread and a biscuit. Reproducibility was estimated by means of the intraclass correlation coefficient (ICC). With the exception of one item concerning chewing duration, all items showed good to excellent intra-observer agreement (ICC students: 0.73-1.0). With the exception of chewing duration and number of swallows, inter-observer agreement was fair to excellent for all items (ICC experts: 0.68-1.0 and ICC students: 0.42-1.0). Results indicate that this tool is a feasible instrument and could be used in clinical practice after further research is completed on the reliability of the tool.

Risk factors for deep surgical site infections after spinal fusion.

Surgical site infections (SSI) are undesired and troublesome complications after spinal surgery. The reported infection rates range from 0.7 to 11.9%, depending on the diagnosis and the complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. Because the medical, economic and social costs of SSI are enormous, any significant reduction in risks will pay dividends. The purpose of this study is to compare patients who developed deep SSI following lumbar or thoracolumbar spinal fusion with a randomly selected group of patients who did not develop this complication in order to identify changeable risk factors. With a case-control analysis nested in a historical cohort of patients who had had a spinal fusion between January 1999 and December 2008, we identified 36 cases with deep SSI (CDC criteria). Information regarding patient-level and surgical-level risk factors was derived from standardized but routinely recorded data and compared with those acquired in a random selection of 135 uninfected patients. Univariate analyses and a multivariate logistic regression were performed. The overall rate of infection in 1,615 procedures (1,568 patients) was 2.2%. A positive history of spinal surgery was associated with an almost four times higher infection rate (OR = 3.7, 95% BI = 1.6-8.6). The risk of SSI increased with the number of levels fused, patients with diabetes had an almost six times higher risk and smokers had more than a two times higher risk for deep SSI. The most common organism cultured was Staphylococcus aureus. All infected patients underwent at least one reoperation, including an open débridement and received appropriate antibiotics to treat the organism. Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery. Total costs associated with preventive measures are substantial and should be compensated by health care insurance companies by means of separate clinical pathways. High-risk patients should be informed about the increased risk of complications.

No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy.

Low back pain (LBP) poses a significant problem to society. Although initial conservative therapy may be beneficial, persisting chronic LBP still frequently leads to expensive invasive intervention. A novel non-invasive therapy that focuses on discogenic LBP is Intervertebral Differential Dynamics Therapy (IDD Therapy, North American Medical Corp. Reg U.S.). IDD Therapy consists of intermittent traction sessions in the Accu-SPINA device (Steadfast Corporation Ltd, Essex, UK), an FDA approved, class II medical device. The intervertebral disc and facet joints are unloaded through axial distraction, positioning and relaxation cycles. The purpose of this study is to investigate the effect of IDD Therapy when added to a standard graded activity program for chronic LBP patients. In a single blind, single centre, randomized controlled trial; 60 consecutive patients were assigned to either the SHAM or the IDD Therapy. All subjects received the standard conservative therapeutic care (graded activity) and 20 sessions in the Accu-SPINA device. The traction weight in the IDD Therapy was systematically increased until 50% of a person's body weight plus 4.45 kg (10 lb) was reached. The SHAM group received a non-therapeutic traction weight of 4.45 kg in all sessions. The main outcome was assessed using a 100-mm visual analogue scale (VAS) for LBP. Secondary outcomes were VAS scores for leg pain, Oswestry Disability Index (ODI), Short-Form 36 (SF-36). All parameters were measured before and 2, 6 and 14 weeks after start of the treatment. Fear of (re)injury due to movement or activities (Tampa Scale for Kinesiophobia), coping strategies (Utrecht Coping List) and use of pain medication were recorded before and at 14 weeks. A repeated measures analysis was performed. The two groups were comparable at baseline in terms of demographic, clinical and psychological characteristics, indicating that the random allocation had succeeded. VAS low back pain improved significantly from 61 (+/-25) to 32 (+/-27) with the IDD protocol and 53 (+/-26) to 36 (+/-27) in the SHAM protocol. Moreover, leg pain, ODI and SF-36 scores improved significantly but in both groups. The use of pain medication decreased significantly, whereas scores for kinesiophobia and coping remained at the same non-pathological level. None of the parameters showed a difference between both protocols. Both treatment regimes had a significant beneficial effect on LBP, leg pain, functional status and quality of life after 14 weeks. The added axial, intermittent, mechanical traction of IDD Therapy to a standard graded activity program has been shown not to be effective.

The Stroke Unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study.

OBJECTIVE: To investigate which factors during the subacute phase post stroke have predictive value for the discharge outcome from the hospital stroke unit. METHODS: In a prospective cohort of 338 patients admitted to a hospital stroke unit 26 potentially prognostic factors, arranged in clinical and social subdomains, were scored and analysed by binary logistic regression analysis. The outcome of the research consisted of the various discharge destinations. RESULTS: The overall predictive value of the discharge model is high (91%). Factors predictive of a poor discharge outcome are a low Barthel Index score (odds ratio (OR) 0.78 per point increase; p < 0.001), a poor sitting balance (OR 5.96; p < 0.001), a depression (OR 7.23; p < 0.001), poststroke cognitive disability (OR 3.51; p = 0.007) and older age (OR 1.05 per point increase; p = 0.008). If present, a personality disorder, premorbid cognitive disability and premorbid functional disability all show a tendency towards poor discharge outcome, but these factors did not reach statistical significance in this study, possibly due to their low prevalence. Readiness of the family circle to provide support was only significant in the univariate analysis. CONCLUSIONS: Somatic, biological and psychological factors predict the discharge outcome. Functional and cognitive factors play a decisive role in the future ability to live independently after a stroke. The prognostic importance of social factors could not be demonstrated. Urinary incontinence did not emerge as a prognostic factor. This is in contrast to scientific findings till now, but in accordance with clinical experience.

The uncemented, titanium-coated rm cup: Survival and analyses of failures.

This study evaluates the incidence of revision of the monoblock, uncemented, titanium-coated RM (Robert Mathys) cup (Mathys Medical, Bettlach, Switzerland) in primary total hip arthroplasty. Between 1991 and 1995 a total of 630 RM cups were implanted in 462 patients. A Kaplan-Meier survival analysis was performed with failure defined as acetabular revision for any reason. The mean follow-up was 8.2 years. A total of 34 acetabular revisions (5%) were carried out: 15 for recurrent dislocation due to cup malposition, nine for wear caused by impingement of a loose femoral component, five for aseptic loosening, only one cup was revised for articular polyethylene wear, and four for other causes. The cumulative survival rate of the RM cup is 91% at 10.7 years, with a worst case scenario of 87%. The cumulative survival rate for aseptic loosening was calculated: 99% at 10.7 years. The titanium-coated RM cup shows an impressive survival rate with revision for aseptic loosening as endpoint. Correct cup positioning is the key to success and requires experience and meticulous surgical technique. (Hip International 2005; 15: 71-7).

Botulinum toxin effect on salivary flow rate in children with cerebral palsy.

OBJECTIVE: To investigate the effectiveness of botulinum neurotoxin (BoNT) type A in reducing salivary flow rate in children with cerebral palsy (CP) with severe drooling. METHODS: During a controlled clinical trial, single-dose BoNT injections into the submandibular salivary glands were compared with scopolamine treatment. Forty-five school-aged children were included. Salivary flow rates from all major glands were obtained at baseline and compared with measurements during the interventions. Basic statistics consisted of analysis of difference scores. RESULTS: Compared with baseline, the mean decrease in submandibular flow was 25% during scopolamine and 42% following BoNT injections. The difference scores were significant with maximum reductions 2, 4, and 8 weeks following BoNT. Of all children, 95% responded during scopolamine. Response rates for BoNT were significantly lower and varied from 69% at 2 weeks to 49% at 24 weeks after injection (the end of the study). Four patients discontinued scopolamine therapy because of side effects. Only incidentally mild side effects were reported from BoNT. CONCLUSIONS: Intraglandular BoNT injections significantly reduce salivary flow rate in the majority of drooling CP children, demonstrating high response rates up to 24 weeks. The procedure is simple to perform, effective, and safe when ultrasound guidance is used. The anticholinergic effect of BoNT exceeds that of scopolamine. As anticholinergic drugs are frequently contraindicated because of side effects, BoNT injections offer an alternative in the treatment of drooling.

Prosthetic prescription in the Netherlands: an interview with clinical experts.

In the process of guideline development for prosthetic prescription in the Netherlands the authors made a study of the daily clinical practice of lower limb prosthetics. Besides the evidence-based knowledge from literature the more implicit knowledge from clinical experts is of importance for guideline development. In order to obtain this information the authors performed both an observational study of clinical practice and an interview study with 11 clinical experts from the three key disciplines in this field. The latter study is presented here as a descriptive and qualitative study. The combination of the opinions on prescription criteria given in these semi-structured interviews appeared divided with regard to various options in the prescription of a lower limb prosthesis. However, the implicit knowledge is considered by the authors of importance for the consensus procedure on guideline development. Prosthetic prescription criteria seem to be based on local experience and partly on assumptions. A consensus procedure can lead to improvement of the knowledge about prosthetic prescription.

A systematic review for evidence of efficacy of anticholinergic drugs to treat drooling.

Drooling frequently occurs in children with multiple handicaps; application of anticholinergic drugs is a potential strategy to treat drooling. A computer aided search of original studies concerning the treatment of drooling was carried out. The methodological and statistical integrity of the identified studies were assessed with previously defined criteria. The articles were weighed for their separate contribution to the evidence. The search resulted in 64 reports, of which seven studies passed the screening and were subjected to further assessment and discussion by three referees. Because of the small number of reports and the methodological restriction within the studies, no meta-analysis could be performed. No general conclusion could be made about the efficacy of anticholinergic drugs in treatment of drooling in children with multiple handicaps. There was some evidence that three anticholinergic drugs (benztropine, glycopyrrolate, and benzhexol hydrochloride) are effective in the treatment of drooling, but it could not be concluded that one drug is preferable.

Pharmacologic treatment of poststroke depression: a systematic review of the literature.

UNLABELLED: CLINICAL QUESTION/OBJECTIVE: A systematic evaluation of the literature published from 1966 until December 2001 on pharmacologic interventions for poststroke depression (PSD). DESIGN: Articles were selected from a computer-based search and were independently reviewed by three evaluators using a standardized criteria including internal validity items as well as descriptive and quantitative items. RESULTS: Fifty studies were preliminarily reviewed and 10 randomized controlled trials (RCTs) were included for systematic analysis. CONCLUSION: Selective serotonin reuptake inhibitors (citalopram and fluoxetine) may be effective in the treatment of PSD. There is some evidence for a beneficial effect of the tricyclic antidepressant nortriptyline, however, the RCTs for this medication lack sufficient validity, and reports on side effects are contradictory.

Prognostic factors in the subacute phase after stroke for the future residence after six months to one year. A systematic review of the literature.

OBJECTIVE: To identify evidence-based prognostic factors in the subacute phase after a stroke for future residence at six months to one year post stroke. DESIGN: Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, PsycLIT and Sociological Abstracts. (2) Reference lists, personal archives and consultation of experts in the field. (3) Guidelines. METHODS: Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for future residence; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration. RESULTS: From 1027 potentially relevant studies 10 studies involving a total of 3564 patients met the inclusion criteria. No prognostic factor was identified in at least two level A (i.e., a good level of scientific evidence according to the methodological score) studies, our standard for scientific proof. The following factors were found in at least one level A study: low initial ADL functioning, high age, cognitive disturbance, paresis of arm and leg, not alert as initial level of consciousness, old hemiplegia, homonymous hemianopia, visual extinction, constructional apraxia, no transfer to the stroke unit, nonlacunar stroke type, visuospatial construction problems, urinary incontinence and female gender. CONCLUSIONS: At present there is insufficient evidence concerning possible predictors in the subacute stage of stroke to make an evidence-based prediction of the future residence. In the scientific research until now social factors and their contribution to the possibility of living independently have not been investigated, or at least less well. None of the studies in this review described a conceptual framework as basis for the choice of the examined prognostic factors.

Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature.

OBJECTIVE: To identify evidence-based prognostic factors in the subacute phase after stroke for activities of daily living (ADL) and ambulation at six months to one year after stroke. DESIGN: Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, Psyclit, and Sociological Abstracts. (2) Reference lists, personal archives, and consultation of experts. (3) Guidelines. METHODS: Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for ADL and ambulation; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration. RESULTS: From 1,027 potentially relevant studies 26 studies involving a total of 7,850 patients met the inclusion criteria. Incontinence for urine is the only prognostic factor identified in three studies with a level A (i.e., a good level of scientific evidence according to the methodological score). The following factors were found in one level A study: initial ADL disability and ambulation, high age, severe paresis or paralysis, impaired swallowing, ideomotor apraxia, ideational apraxia, and visuospatial construction problems; as well as factors relating to complications of an ischaemic stroke, such as extraparenchymal bleeding, cerebral oedema and size of intraparenchymal haemorrhage. CONCLUSIONS: The present evidence concerning possible predictors in the subacute stage of stroke has insufficient quality to make an evidence-based prediction of ADL and ambulation after stroke because only one prognostic factor was demonstrated in at least two level A studies, our cut-off for sufficient scientific evidence.

Prosthetic prescription in the Netherlands: an observational study.

Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to local prescription variations with regard to overuse or underuse of prosthetic care and a lack of transparency for consumers and health insurance companies. Hence a clinical guideline may lead to a more consistent and efficient clinical practice and thus more uniformly high quality care. The purpose of this study was to get insight into potential similarities in prescription criteria in clinical practice in the Netherlands. Secondly, the authors were interested to know if prosthetic prescription was primarily based on the level of activity or intended use of the prosthesis. As part of the development of a consensus-based clinical guideline a multi-centred, cross-sectional study was carried out in order to observe the prosthetic prescription for a group of lower limb amputees. Therefore prescription data were collected from 151 amputees with trans-femoral amputation, knee disarticulation or trans-tibial amputation. Results of the multiple logistic regression show no relationship between the activity level and any of the variables included in the equation such as the hospital or medical doctor in Physical and Rehabilitation Medicine (MD in P&RM), prosthetic components, age of the amputee or reason of amputation. The criteria used are merely based on the clinical expertise and local experience whereas the actual prescriptions differ from location to location. In conclusion the development of a clinical guideline for prosthetic prescription in lower limb amputation is recommended. The information gained from this observational study will be used in a clinical guideline procedure for prosthetic prescription in the Netherlands.

Treatment of upper extremity spasticity in stroke patients by focal neuronal or neuromuscular blockade: a systematic review of the literature.

Studies published from January 1966 until October 2000 on the clinical effects of focal neuronal and neuromuscular blockade in post stroke upper limb spasticity were identified. Twelve studies were included and evaluated on 13 methodological criteria. Ten studies on Botulinum toxin type A (BTX-A) treatment were found (of which 4 were randomised controlled trials (RCTs) and 6 were uncontrolled observational studies) as well as one uncontrolled observational study on phenol blockade of the subscapular muscle and one on alcohol blockade of the musculocutaneus nerve. The homogeneity of the patient groups with regard to diagnosis and their comparability with regard to functional prognosis and other sources of bias were generally unsatisfactory. Only two RCTs met predetermined criteria of minimal validity. There is evidence of effectiveness of BTX-A treatment on reducing muscle tone (varying between 0.8 and 2.0 points on the modified Ashworth scale) and improving passive range of motion at all arm-hand levels in chronic stroke patients for approximately 3-4 months. There is also preliminary evidence of a synergistic effect of concomitant electrostimulation. Taking into account a critical maximum dose of 100 MU Botox" (300-500 MU Dysport) for preserving active finger flexion, BTX-A treatment seems to be a safe focal spasmolytic treatment. Effectiveness of BTX-A treatment on improving functional abilities could not be convincingly demonstrated, although two subgroups may be identified that might specifically benefit at a functional level: (1) patients with mild spasticity and a potential for voluntary extensor activity and (2) patients with severe spasticity suffering from problems with positioning and taking care of the affected arm and hand. Larger controlled studies are needed to compare the effectiveness of BTX-A with other focal spasmolytic techniques paying special attention to individual goal assessment, the (duration of) functional benefits, co-treatment and aftercare, side-effects and cost-effectiveness.

Is there a relation between neuropsychologic variables and quality of life after stroke?

OBJECTIVES: To describe the quality of life (QOL) of stroke patients and to distill neuropsychologic predictors for poor QOL. DESIGN: A cohort study in which patients were neuropsychologically assessed at a mean of 72.2 days after stroke, with follow-up at a mean of 9.8 months after stroke. SETTING: Research department of a rehabilitation center. PATIENTS: A consecutive sample of 164 stroke patients (mean age, 55.2yr) recruited from a university hospital, a regional hospital, and a rehabilitation center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Orientation, memory, attention and concentration, visuospatial and visuoconstructive functions, language, and arithmetic skills were assessed with neuropsychologic tests. QOL was assessed with the Sickness Impact Profile (SIP). RESULTS: An overall mean SIP score +/- standard deviation of 20 +/- 11 showed that stroke has a high impact on everyday functioning. Further analyses indicated that QOL is related in particular to tests measuring spatiotemporal and/or sequential aspects of behavior. Forward/backward stepwise regression analysis (n = 106) showed that poor QOL was more likely if patients had a poor result on the Trailmaking Test (TMT) B and/or were women. CONCLUSION: The predictive value of the TMT is most effective and very useful because the TMT is a short and economical procedure. However, the gender-related aspects of recovery deserve more attention, as does the possible bias that can be caused by the composition of a measurement. Further research is needed to refine predictive models that are needed to facilitate the development of more adequate, individual rehabilitation programs.

Urinary incontinence in stroke patients after admission to a postacute inpatient rehabilitation program.

OBJECTIVE: To determine the incidence of poststroke urinary incontinence in stroke patients admitted for a postacute inpatient rehabilitation program and its association with discharge destination. DESIGN: Cohort study of first-time stroke patients admitted for a postacute inpatient rehabilitation program from August 1994 to August 1997. SETTING: Rehabilitation center in the Netherlands. PARTICIPANTS: Consecutive first-time stroke patients (n = 143). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incidence rates calculated with observation time at risk in the denominator. Measures for outcome include the Modified Barthel Index (MBI) and the discharge destination. RESULTS: The incidence rate of urinary incontinence was 29/1000 persons per month (95% confidence interval [CI], 18-48/1000 persons monthly). For incontinent patients, the mean initial MBI score +/- standard deviation was 6.0 +/- 2.3 (range, 2-12); for continent patients, it was 11.5 +/- 9.8 (range, 2-18). This difference was statistically significant (t(139) = 2.12; p = .036; 95% CI for difference of the means, .379-10.84). Patients continent at time of discharge were more often discharged to their own homes than were incontinent patients (Fisher's exact test, p = .0006). CONCLUSIONS: In this select cohort, the incidence of urinary incontinence was lower than that reported in the literature. An association was found between urinary incontinence and discharge destination and between urinary incontinence and functional ability on admission.

Results with the M. E. Müller cemented, straight-stem total hip prosthesis: a 10-year historical cohort study in 180 women.

In 1986, 242 M. E. Muller (MEM) cemented, straight-stem total hip arthroplasty prostheses were implanted in 229 patients; 15 hips (13 patients) were lost to follow-up. Of the remaining 227 implants, 180 were placed in women, and 47 were placed in men (each with mean age, 71 +/- 7.7 years). After 10 years, 66 patients had died, and 152 implants were still in situ. As a result of aseptic loosening, 9 hips were revised (5 femoral and 4 acetabular components); two of these patients had a Girdlestone as a result of postoperative infection. Because 50% of the men died during follow-up, further analysis was performed with the 180 implants in women. The incidence of revision for aseptic loosening was 5.9 per 1,000 implants. The cumulative survival rate after 10 years was 94%. Survival was not influenced significantly by age, indication for operation, or having a contralateral hip prosthesis. The 10-year follow-up results for the MEM straight-stem total hip prosthesis in our hospital are satisfactory despite the probability that the cement mantle produced with this stem is not uniform in thickness.